Provider Demographics
NPI:1023087897
Name:BORDELON, MONICA COURVILLE (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:COURVILLE
Last Name:BORDELON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W BONAIRE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6626
Mailing Address - Country:US
Mailing Address - Phone:337-981-4982
Mailing Address - Fax:
Practice Address - Street 1:202 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-3623
Practice Address - Country:US
Practice Address - Phone:337-896-8434
Practice Address - Fax:337-896-4654
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist